Search

Purpose This study aims to analyze the use of autogenic auricular cartilage grafts as weight for the upper eyelid in conjunction with lateral canthopexy for patients with mild paralytic lagophthalmos. This procedure was also accompanied by elevation of the lower eyelid using the cartilage graft for moderate cases. Methods We conducted a retrospective study including case series of 30 patients with paralytic lagophthalmos from 1997 to 2010. For mild cases, cartilage from the auricular scapha was placed in pretarsal space of the upper eyelid and cartilage from the concha was inserted in preaponeurotic space and then sutured to the levator aponeurosis in conjunction with lateral canthopexy. For moderate cases, lower eyelid was also elevated by suturing cartilage graft to tarsum and resting it by the inferior orbital rim. Results All patients had some degree of keratopathy before the intervention. After treatment, they presented with evident clinical improvement, reduction of eye symptoms, and resolution of keratopathy. During the mean postoperative follow-up of 37.3 months, none of the patients presented with cartilage graft exposition, reabsorption, visibility, infection, or warping. Complete eye closure was achieved in 24 (80%) patients, whereas the remaining 6 (20%) patients had residual asymptomatic lagophthalmos. Conclusions The intervention using autogenic auricular cartilage grafts explained in this study was only effective for the treatment of mild and moderate cases of paralytic lagophthalmos. This outpatient surgery is associated with low morbidity and achievement of functional and aesthetic improvement.

Parkinson disease (PD) can be considered as a brain multisystemic disease arising from dysfunction in several neural networks. The principal aim of this study was to assess whether large‐scale structural topological network changes are detectable in PD patients who have not been exposed yet to dopaminergic therapy (de novo patients). Twenty‐one drug‐naïve PD patients and thirty healthy controls underwent a 3T structural MRI. Next, Diffusion Tensor Imaging (DTI) and graph theoretic analyses to compute individual structural white‐matter (WM) networks were combined. Centrality (degree, eigenvector centrality), segregation (clustering coefficient), and integration measures (efficiency, path length) were assessed in subject‐specific structural networks. Moreover, Network‐based statistic (NBS) was used to identify whether and which subnetworks were significantly different between PD and control participants. De novo PD patients showed decreased clustering coefficient and strength in specific brain regions such as putamen, pallidum, amygdala, and olfactory cortex compared with healthy controls. Moreover, NBS analyses demonstrated that two specific subnetworks of reduced connectivity characterized the WM structural organization of PD patients. In particular, several key pathways in the limbic system, basal ganglia, and sensorimotor circuits showed reduced patterns of communications when comparing PD patients to controls. This study shows that PD is characterized by a disruption in the structural connectivity of several motor and non‐motor regions. These findings provide support to the presence of disconnectivity mechanisms in motor (basal ganglia) as well as in non‐motor (e.g., limbic, olfactory) circuits at an early disease stage of PD. Hum Brain Mapp 37:4500–4510, 2016. © 2016 Wiley Periodicals, Inc.

We describe a case of a 14-years old caucasian female affected by autoimmune hemolytic anemia and thrombocytopenia successfully treated with intravenous immunoglobulin and steroids. Nevertheless, neutropenia occurred during follow-up period. Positivity of direct antiglobulin test and sieric anti-neutrophil antibodies suggested the diagnosis of Evans syndrome trilineage.

Patients with severe ptosis caused by poor or absent function of the levator muscle but with good frontalis muscle excursion usually benefit from a frontalis sling procedure. This is currently carried out using organic or inorganic material to connect the upper eyelid to the frontalis muscle.The aim of this study was to evaluate retrospectively 112 patients who underwent frontalis sling procedures between 1989 and 2011 using a preformed silicone implant suspensor to correct severe ptosis.The results obtained using this technique were good or fair in 95.54 percent of the cases and poor in 4.46 percent of the cases. The authors discuss the results of the study and the cases in which the procedure should be indicated and highlight the advantages of the method.The availability of this low-cost sterile device, together with the fact that it is ready to use, requires less invasive surgery, saves time, and is sufficiently versatile to allow adjustments to be made at any time, makes the silicone eyelid sling an attractive choice for correcting ptosis.Therapeutic, IV.

Background: Blepharophimosis is a rare autosomal-dominant syndrome involving the periorbital region. It is characterized mainly by eyelid ptosis, palpebral phimosis, telecanthus, and epicanthus inversus. Methods: Ten patients ranging in age from 2 to 22 years who presented with blepharophimosis were retrospectively studied over the past 14 years; they had an average follow-up of 7 years and 5 months. They were treated at the Division of Plastic Surgery of the Faculty of Medicine, University of Sao Paulo. Eight patients presented with the complete form, including epicanthus, telecanthus, and severe palpebral ptosis, and two presented with the incomplete form. The epicanthi and telecanthi were corrected with Mustarde’s technique, and the ptosis was treated by frontalis suspension with a soft, preformed silicone device called the silicone implant suspensor. Results: The results were classified as good, fair, and poor, according to the postoperative position of the upper eyelid in relation to the scleral limbus, medial canthus position, and residual epicanthal fold. The results were assessed as good in seven cases and fair in three. Conclusions: The silicone eyelid suspensor was effective in improving the patients’ difficult condition. It was a better alternative than the use of fascia lata, because it permitted an easier readjustment of the eyelid margin and it offered the possibility of creating a well-defined palpebral fold, which is usually absent in this group. The results were maintained with long-term follow-up. The silicone suspensor was safe and long-term results were good in both children and adults.

The authors evaluated the efficacy and safety of an OPAT program in a small group of patients affected by infective endocarditis. Three patients were considered eligible for the treatment; i.e. they had a stable hemodynamic balance and no embolic events. Streptococcus spp. grew in blood cultures of two patients, while blood cultures were negative in the third patient. Long-acting antibiotics were used and all patients recovered from the infection without adverse events. The treatment was efficacious and safe. This preliminary experience suggests that OPAT programs can be promoted in infective endocarditis with advantage. Strictness and caution are necessary in screening and monitoring patients.

The authors analysed retrospectively the clinical and laboratory features of patients hospitalised in a unit of infectious diseases in the period from 1996-99. In particular, the etiology, the antimicrobial susceptibility of responsible microorganisms, criteria utilized for diagnosis, antibiotic courses and outcomes were evaluated and discussed. Echocardiography is an essential tool in the diagnosis. Infective endocarditis remains a serious infection and is still associated with high morbidity and mortality rate, despite appropriate treatment. Seriously ill patients may require prompt surgery.

Mutant ras genes occur frequently in human neoplasia and, in particular, in pancreatic, colorectal, and lung adenocarcinomas. Recent evidence suggests that G--T and G--C transversions of the Ki-ras gene in codon 12 may lead to biological effects in vitro and in vivo that may be associated with an abnormal cell cycle and increased tumour aggressiveness. The role of Ki-ras activation (a G--C transversion in codon 12, arginine for glycine) in the cell cycle and apoptosis was investigated using control and permanently transfected NIH3T3 mouse fibroblasts. Flow cytometry was used to evaluate the G1-, S- and G2M-phase transit times, the potential doubling time, the growth fraction, and the cell loss factor during asynchronous exponential growth. Apoptosis was induced in both cell lines by absence of growth factors for an extended period of time (72 h) and quantitatively evaluated using the TUNEL method coupled with flow cytometry. It was found that codon 12 G--C Ki-ras transfected cells compared with controls, had a significant prolongation of G1 by about 50%, a reduction of the G2M transit time by 30%, and a decrease of the cell loss factor by about 90%. Apoptotic cells were about 10% in control and less than 0.5% in Ki-ras transfected cells after 72 h starvation-confluency. These data suggest that codon 12 G--C Ki-ras activation in mouse NIH3T3 fibroblasts is associated with deregulation of checkpoint controls in the G1 and G2M phases of the cell cycle and inhibition of apoptosis. It appears plausible that these cell mechanisms are related to a proliferative advantage and that they may also be important in the progression of human tumours characterized by specific Ki-ras mutations.

Detailed information about intratumor K-ras2 mutations in colorectal adenocarcinomas and a possible association with DNA content heterogeneity is still lacking. DNA diploid and aneuploid subclones, detected among multiple histologically selected primary sectors (57 superficial and 40 deep) and 9 lymph node metastases, were flow cytometrically sorted and separately submitted to codons 12-13 K-ras2 mutation spectrum analysis. DNA aneuploidy was absent among 20 near and 20 distant mucosa sites and present in 7/9 lymph node metastases and in 17/19 primary tumors (90%). Primary intratumor DNA multiclonality was approximately 50%. Degree of DNA aneuploidy (DNA Index) distribution was nonrandom and showed peaks at approximate mean DNA Index values 1.2, 1.5, and 1.8. K-ras2 mutations were detected in 0/20 mucosa cases, in 2/9 lymph node metastases, and in 9/19 adenocarcinomas (47%). No more than one mutation type per tumor was detected. Intratumor distribution of K-ras2 mutations was homogeneous in 6 and heterogeneous in 3 cases. Homogeneous distribution was associated with DNA near-diploid aneuploidy. K-ras2 mutations were strongly associated with DNA Index in the near-diploid region (83%) and almost absent (5%) among DNA near-triploid subclones (P = 0.0001). K-ras2 mutation intratumor heterogeneity indicates that sampling of the tumor may be a critical step and suggests that K-ras2 activation may be a late event in a subgroup of tumors. Our data also suggest the existence of an early process of the colorectal carcinogenesis that favors both K-ras2 mutations and DNA near-diploid aneuploidy. Onset of DNA near-triploid subclones appears, instead, to be independent from K-ras2 activation.

The authors evaluated the efficacy and tolerance of low dose lymphoblastoid alpha interferon in 14 i.v. drug addicts with histologically confirmed chronic active hepatitis C. Patients were treated for 12 months; all completed the whole treatment without complaining of significant side effects. Four months after withdrawal of treatment, 13 patients were found to be in clinical and biohumoral remission with serum transaminases within the normal range already after 12 weeks.

The authors have completed a retrospective study on closing base wedge osteotomies. This review includes preoperative and postoperative clinical and radiographic evaluation. A total of 61 procedures were evaluated on 47 patients. All procedures were performed at The Podiatry Hospital of Pittsburgh. Subjective analysis of patient acceptance is included, as well as an in-depth discussion of surgical technique, with emphasis on fixation.

Bartolomei, S, Nigro, F, Gubellini, L, Ciacci, S, Merni, F, Treno, F, Cortesi, M, and Semprini, G. Physiological and sport-specific comparison between Division I and Division II Italian male field hockey players. J Strength Cond Res 33(11): 3123-3128, 2019-The purpose of this study was to compare the anthropometric and performance profiles of Division I (D1) and Division II (D2) Italian field hockey players. Fifteen DI players and 15 D2 players (age = 25.4 ± 5.2 years; body mass = 78.5 ± 9.0 kg; and body height = 179.6 ± 7.8 cm) were assessed on one occasion for anthropometry, body composition, physiological measurements, and sport-specific skills. Differences between the 2 groups were evaluated using a 1-way analysis of variance. Pearson correlations were used to examine relationships between the different measurements. Significantly (p = 0.039) lower percentages of body fat were found on D1 group compared with D2 group (-3.5%). A significant difference between the groups were noted for shooting accuracy (p = 0.013), with the D1 group performing 14.5% better than the DII group. No significant differences between the groups were found for shooting speed (p = 0.103) and slalom and dribbling performances (p = 0.292 and p = 0.416, respectively). Physiological assessments did not show any significant differences between the groups. Large correlations (r = 0.73; p < 0.001) were found between shooting speed and accuracy. Moderate correlations were observed between the shooting speed and the hand grip strength, in particular of the left hand (r = 0.61; p = 0.007). Results of this study indicate that the difference between D1 and D2 players may be more related to technical factors than to physical fitness. Ball control, however, may not be a limiting factor in D2 players.